Vólvulo cecal: reporte de un caso / Cecal volvulus: a case report

El vólvulo cecal es una causa rara de abdomen oclusivo agudo. Cada año, aproximadamente 2,8-7,1 personas por millón se ven afectadas por esta patología. Se estima que el vólvulo cecal representa el 25-40% de todo el vólvulo del colon. Causa alrededor del 1-1,5% de las oclusiones intestinales en adultos. La mayoría de los pacientes presentan síntomas de hinchazón, estreñimiento, náuseas y vómitos. Hasta el 50% puede tener síntomas intermitentes antes de la torsión. Su baja prevalencia dificulta su diagnóstico preoperatorio, siendo diagnosticado frecuentemente durante la cirugía. Presentamos el caso de un hombre de 66 años que ingresa por dolor abdominal, cuyos métodos de imagen complementarios iniciales fueron diagnósticos de abdomen agudo oclusivo y finalmente durante la cirugía se observó un vólvulo cecal

The cecal volvulus is a rare cause of an acute occlusive abdomen. Each year, approximately 2.8-7.1 people per million are affected by this pathology. It is estimated that the cecal volvulus represents 25-40% of all the colon volvulus. Causing about 1-1.5% of intestinal occlusions in adults. Most patients have symptoms of bloating, constipation, nausea, and vomiting. Up to 50% may have intermittent symptoms before torsion. Its low prevalence hinders its preoperative diagnosis, being frequently diagnosed during surgery. We present a case of a 66-year-old man admitted for abdominal pain, whose initial complementary imaging methods were diagnostic of acute occlusive abdomen and finally a cecal volvulus was observed during surgery

Mucocele apendicular gigante: reporte de un caso y revisión de la literatura / Giant appendiceal mucocele: case report and review of the literature

El mucocele apendicular (MA) corresponde a una dilatación quística del lumen apendicular rellena por mucus en su interior; secundario a etiologías de naturaleza benigna (hiperplasia mucinosa y cistoadenoma) o maligna (cistoadenocarcinoma).Se trata de una condición infrecuente, reportándose en no más allá del 0,3 por ciento de las apendicectomías. Su tamaño y manifestaciones clínicas son extremadamente variables, permitiendo el estudio anatomo-patológico de la pieza quirúrgica establecer el diagnóstico etiológico. Presentamos el caso de un MA gigante secundario a un cistoadenoma mucinoso, diagnosticado en un hombre de 57 años en la Unidad de Anatomía Patológica del Hospital Hernán Henríquez Aravena de Temuco...

Appendiceal mucocele (AM) is a cystic dilatation of the appendiceal lumen filled by mucus inside, secondary to benign etiologies (hyperplasia and mucinous cystadenoma) or malignant (cystadenocarcinoma). This condition is uncommon, being reported in no more than 0.3 percent of appendectomies. Its size and clinical manifestations are extremely variable, allowing the pathological analysis of the surgical specimen etiologic diagnosis. We report a case of a giant AM secondary to a mucinous cystadenoma diagnosed in a 57-year-old man in the Pathology Unit of Hospital Hernán Henríquez Aravena of Temuco...

[Appendicular endometriosis as a cause of acute abdomen]. / Endometriosis apendicular como causa de abdomen agudo.

Endometriosis affects between 4 and 17% of women of reproductive age. The intestinal endometriosis affects 3 to 12% of women and is usually asymptomatic when it affects the subserosa or serosa; 0.7 to 2.5% of patients require surgical treatment for symptomatic lesions with diarrhea, constipation, pain and hematochezia. We report a case of a patient with appendiceal endometriosis in which the diagnosis was made during an emergency surgery and histopathology reported involvement of the muscle wall and serosa.

Endometriosis at several sites, cyclic bowel symptoms, and the likelihood of the appendix being affected.

In patients with endometriosis of the appendix, other sites are use to be affected by the disease, mainly bladder, rectosigmoid and retrocervical endometriosis. When these characteristics are present or if patients have more than three sites affected by endometriosis, the surgeon should evaluate the appendix carefully.

Pathological findings in the caeca of naturally infected ostriches, Struthio camelus Linnaeus, 1758 (Aves, Struthionidae) parasitized by Codiostomum struthionis (Horst, 1885) Railliet and Henry, 1911 (Nematoda, Strongylidae).

In order to characterize lesions associated with Codiostomum struthionis in ostriches, 10 caeca were examined on both macro- and microscopic levels. Parasites were found in the distal third of the caecum and characterized as C. struthionis. Thickened mucosa was identified macroscopically where parasites were observed in high concentrations. Nodular areas were also observed in the distal third of the infected caeca, as well as hemorrhagic areas abutting small ulcers surrounded by edema. These findings were not observed in healthy controls. The concentration of C. struthionis found in infected animals was directly correlated with the severity of lesions observed in each caecum. These results allowed us to infer that C. struthionis is responsible for lesions in ostrich caeca.

Ulcera benigna de ciego / Benign cecal ulcer

Introducción: La úlcera benigna de ciego es una entidad poco frecuente, que en general no se la considera entre los diagnósticos diferenciales de las patologías agudas y crónicas del colon. Objetivo: Evaluar el comportamiento actual de una patología infrecuente del colon, a partir de cuatro casos clínicos. Lugar de aplicación: Institución privada. Pacientes y Métodos: Se presentan cuatro pacientes operados con diagnóstico anatomopatológico de úlcera benigna de ciego, entre mayo de 1996 y marzo de 2008, tres hombres y una mujer, con un promedio de edad de 70.75 años (rango 59 a 83 años). Resultados: La presentación clínica fue síndrome de fosa ilíaca derecha, hemorragia digestiva baja, obstrucción intestinal y tumor de colon. En ningún caso se obtuvo diagnóstico preoperatorio mediante estudios por imágenes. En los cuatro casos se realizó colectomía derecha, tres por vía convencional y una videoasistida. No hubo mortalidad. Un paciente presentó infección de herida quirúrgica. Conclusiones: Es una patología difícil de diagnosticar en forma pre o intraoperatoria. Su etiología es desconocida. Actualmente se relaciona con la ingesta de antiinflamatorios no esteroides e infección por citomegalovirus en pacientes trasplantados. Por medio de la colonoscopía y biopsia se puede realizar tratamiento conservador. La cirugía está indicada en las complicaciones de la enfermedad o ante la sospecha de tumor del colon.

Introduction: The benign cecal ulcer is a rare entity, which generally is not considered among differentials diagnosis of the acute or chronic colon pathologies. Objective: To assess the current behaviour of a rare colonic entity, from four clinical cases. Point of application: Private Institution. Patients and Methods: Four patients operated with anatomopathological diagnosis of benign cecal ulcer, between May 1996 and March 2008, three men and one woman, with an average age of 70.75 years (range 59 to 83 years). Results: The clinical presentations were right iliac fossa syndrome, lower gastrointestinal bleeding, intestinal obstruction, tumor of the colon. No preoperative diagnosis were obtained through imaging studies. In all four cases right colectomy was performed, three conventional and one videoassisted. There was no mortality. One patient had wound infection. Conclusions: It is a difficult pathology to diagnose preoperatively or intraoperatively. The ethiology is unknown. Actually it is related to the intake of nonsteroidal anti-inflammatory drugs and cytomegalovirus infection in transplant patients. Through the colonoscopy and biopsy conservative treatment can be performed. Surgical intervention is necessary when complications are present or if malignancy is suspected.

Diverticulitis cecal como causa de abdomen agudo quirúrgico. Presentación de un caso / Cecal diverticulitis as a cause of surgical acute abdomen

The unique cecal diverticulitis is a rare event in the occidental population with a difficult pre-surgical diagnosis. The observation of this entity encountered during the development of a laparoscopy because a supposed diagnosis of acute apendicitis, motivated this report.

[Isolated Crohn's disease of the appendix as a source of enterorrhagia]. / Doença de Crohn isolada do apêndice cecal como causa de enterorragia.

BACKGROUND: Crohn's disease confined to the appendix is relatively rare as a sole primary manifestation of the disease. Young people are more affected. The medical history and the physical examination are similar to the findings in acute appendicitis, but the manifestations are protracted. On physical examination there are signs of peritoneal irritation and an abdominal mass is palpable in the right iliac fossa. AIMS: To report a case of Crohn's disease confined to the appendix and presenting with enterorrhagia. The source of the bleeding was localized by colonoscopy. PATIENT: A 16-year old caucasian male without past history of gastrointestinal symptoms, presented with two episodes of enterorrhagia within a period of one year. In the second episode colonoscopy identified the appendicular ostium as the source of bleeding. RESULTS: At operation the cecum and terminal ileum were normal in thickness and texture, and an inflammatory appendix adherent to the omentum was removed. Microscopically there were non-caseating granulomas, intense infiltration of the wall with plasma cells, lymphocytes and macrophages. The patient has not suffered recurrence, and a colonoscopy realized 2 years after the operation did not show signs of Crohn's disease. CONCLUSION: This case, like others in the literature, appendectomy is curative, but a 5-year follow-up is mandatory. When a young patient presents with enterorrhagia, this diagnosis has to be considered.

Estudo da influência do dreno de Penrose na cicatrização de lesão contaminada no ceco de ratos / Study of the Penrose drain influence in rats cecum contaminated injuries

Racional - A utilização de drenos na cavidade abdominal define-sepor princípios específicos, aspectos da experiência pessoal e por vezes em indicações empíricas. A experimentação define critérios que auxiliam as decisões do cirurgião...

Nodular typhlitis associated with the nematodes Heterakis gallinarum and Heterakis isolonche in pheasants: frequency and pathology with evidence of neoplasia.

An investigation related to the frequency and pathology of Heterakis gallinarum and pathology of Heterakis isolonche in pheasants from Rio de Janeiro, Brazil was conducted by means of clinical examinations, necropsies, and histopathological analysis in 50 ring-necked pheasants from backyard flocks of 11 localities; also, histological sections of caeca of golden pheasants deposited in the Helminthological Collection of the Oswaldo Cruz Institute (CHIOC) have been considered in the present study. During necropsies, only specimens of H. gallinarum were recovered with a prevalence of 90%, mean intensity of 81.9 and range of infection of 1-413. Gross lesions were characterized by congestion, thickening, petechial haemorrhages of the mucosa, intussusception, and nodules in the cecal wall. Under microscopy, chronic diffuse typhlitis, haemosiderosis, granulomas with necrotic center in the submucosa and leiomyomas in the submucosa, muscular and serosa associated with immature H. gallinarum worms were observed. The examination of histological sections previously deposited in the CHIOC, revealed more severe alterations associated with concomitant infections with H. gallinarum and H. isolonche in golden pheasants, and were characterized by several necrotic areas with cholesterol clefts in the submucosa, giant cell granulomas in the submucosa, and serosa centralized by necrosis and worm sections and neoplastic nodules in the muscular and submucosa.

Mucocele gigante do apêndice: relato de caso / Giant mucoceles of the appendix: case report

Mucocele do apêndice é uma entidade rara que ocorre devido à obstruçäo do lúmen ou como seqüela de neoplasias malignas ou benignas desse órgäo. Os autores relatam um caso de mucocele gigante do apêndice em uma mulher de 44 anos cujo quadro de apresentaçäo foi de abdome agudo inflamatório. Säo discutidos aspectos clínicos, anatomopatológicos e terapêuticos da doença

Endometriosis of the appendix with decidual polyp formation: a rare cause of acute appendicitis during pregnancy.

We report a case of a 28-year-old female, Grava 2, Para I, Ab. 0, who presented acute abdominal pain on the 21st week of her gestation. A diagnosis of acute appendicitis was entertained and an appendectomy performed. The pathologic specimen revealed an inflamed appendix with endometriosis and a marked decidual reaction. A decidual polyp, which occluded most of the appendiceal lumen, is proposed as a rare cause of acute appendicitis during pregnancy.

Endometriosis of the appendix with decidual polyp formation: a rare cause of acute appendicitis during pregnancy

We report a case of a 28-year-old female, Grava 2, Para I, Ab. 0, who presented acute abdominal pain on the 21st week of her gestation. A diagnosis of acute appendicitis was entertained and an appendectomy performed. The pathologic specimen revealed an inflamed appendix with endometriosis and a marked decidual reaction. A decidual polyp, which occluded most of the appendiceal lumen, is proposed as a rare cause of acute appendicitis during pregnancy

[Pathology of the cecal appendix in our country. An analysis of 936 surgical specimens of appendectomy]. / La patología del apéndice cecal en nuestro medio. Un analisis de 436 especimenes quirurgicos de apendicectomía.

Analysis was made of 436 specimens of appendectomy in the Caracas University Hospital during the year 1.990. Ages of the patients ranged between 9 months and 79 years (average age: 21 years). 236 were males and 200 females. The pathology found most frequently was the acute inflammatory processes, followed by secondary reactive changes to other entities, many of which were unspecified (e.g. pelvic inflammatory disease) and other specific (such as infestation by parasites) less frequently were found tumoral processes such as mucocele, carcinoid tumor and those which involved another portion of the digestive apparatus and which secondarily affect the appendix.